Related Experiment Video
Updated: Apr 23, 2026
Translational Brain Mapping at the University of Rochester Medical Center: Preserving the Mind Through Personalized Brain Mapping
Published on: August 12, 2019
Impact of preoperative functional magnetic resonance imaging during awake craniotomy procedures for intraoperative
Victoria T Trinh1, Daniel K Fahim, Marcos V C Maldaun
1Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Tex., USA.
Background:
We wanted to study the role of functional MRI (fMRI) in preventing neurological injury in awake craniotomy patients as this has not been previously studied.
Objectives:
To examine the role of fMRI as an intraoperative adjunct during awake craniotomy procedures.
Methods:
Preoperative fMRI was carried out routinely in 214 patients undergoing awake craniotomy with direct cortical stimulation (DCS).
Results:
In 40% of our cases (n = 85) fMRI was utilized for the intraoperative localization of the eloquent cortex. In the other 129 cases significant noise distortion, poor task performance and nonspecific BOLD activation precluded the surgeon from using the fMRI data. Compared with DCS, fMRI had a sensitivity and specificity, respectively, of 91 and 64% in Broca's area, 93 and 18% in Wernicke's area and 100 and 100% in motor areas. A new intraoperative neurological deficit during subcortical dissection was predictive of a worsened deficit following surgery (p < 0.001). The use of fMRI for intraoperative localization was, however, not significant in preventing worsened neurological deficits, both in the immediate postoperative period (p = 1.00) and at the 3-month follow-up (p = 0.42).
Conclusions:
The routine use of fMRI was not useful in identifying language sites as performed and, more importantly, practiced tasks failed to prevent neurological deficits following awake craniotomy procedures.
Insights
Functional MRI (fMRI) did not prevent neurological deficits in awake craniotomy patients. Routine fMRI use for localizing eloquent cortex was not effective in improving patient outcomes.
Area of Science:
- Neurosurgery
- Neuroimaging
- Clinical Neurology
Background:
- Functional MRI (fMRI) has not been previously studied for its role in preventing neurological injury during awake craniotomy.
- Awake craniotomy requires precise localization of eloquent brain areas to minimize surgical risk.
Purpose of the Study:
- To examine the utility of fMRI as an intraoperative tool during awake craniotomy.
- To assess if fMRI can help prevent neurological deficits in patients undergoing awake craniotomy.
Main Methods:
- Preoperative fMRI was performed on 214 patients scheduled for awake craniotomy with direct cortical stimulation (DCS).
- fMRI data was utilized for intraoperative localization of eloquent cortex when feasible; limitations included noise, poor task performance, and nonspecific activation.
Main Results:
- fMRI was successfully used for intraoperative localization in 40% of cases.
- fMRI demonstrated high sensitivity and specificity in motor areas but variable performance in language areas (Broca's and Wernicke's).
- The use of fMRI for intraoperative localization did not significantly prevent worsened neurological deficits post-surgery.
Conclusions:
- Routine preoperative fMRI was not effective in identifying language sites during awake craniotomy.
- Practiced tasks and fMRI localization failed to prevent neurological deficits following awake craniotomy procedures.
